A 15-year-old girl is admitted to the pediatric intensive care unit with a long history of weight loss and a serum sodium concentration of 189 mmol/L. She has been following a meal plan to gain weight and recently has stopped running 5 miles a day. Her fluid intake is approximately 16 oz of water a day. She denies fear of weight gain and body image disturbances, and a symptom review is negative. Physical examination reveals an alert and cooperative adolescent girl. Weight is 68 lb (3%); height, 62.75 in (34%); body mass index (BMI), 12.14 (3%); blood pressure, 113/74 mm Hg; heart beat, 67 beats/ minute; and axillary temperature, 36°C. She has no signs of pubertal development and is mildly dehydrated. After extensive evaluation, she is determined to have an underlying eating disorder with no primary medical diagnosis. She is discharged from the hospital on day 16 without any complications, with follow-up care by an adolescent medicine specialist and therapist.
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